Basic Information
| Provider Information | |||||||||
| NPI: | 1114474954 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDRZEJEWSKI | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MS, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4240 53RD AVE W APT 2706 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342104412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455111 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3823 E STATE ROAD 64 | ||||||||
| Address2: | |||||||||
| City: | BRADENTON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342089041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9417455111 | ||||||||
| FaxNumber: | 9417455667 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/09/2016 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA14698 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.